ALEXIS GRANT, Copyright 2007 Houston Chronicle |
October 28, 2007

Ophthalmology residents at The University of Texas Medical School at Houston listen to Dr. Judianne Kellaway on Monday. Kellaway, assistant dean of admissions at the school, says the process of getting into medical school has become more competitive.

Enrollment is increasing sharply at medical schools across the country, a trend that's expected to help the nation combat a worsening shortage of physicians.

But it's also focusing attention on the need to expand the other half of the physician pipeline: residency programs.

A record number of students enrolled at medical schools this fall, including those in Houston, Salsberg's group reported recently. But the higher numbers also mean more training positions in hospitals will be needed after those students graduate in four years.

The enrollment jump was largely in response to the AAMC's appeal to the nation's 126 medical schools last year to increase class size by nearly one-third by 2015. This year's increase to about 17,800 first-year students represents an 8 percent increase since 2002, the group's benchmark year.

Medical schools in Houston are contributing to that increase. The University of Texas Medical School at Houston enrolled 230 first-year students this fall, up 12 percent from 206 students in 2002. And Baylor College of Medicine plans to increase its first-year class to 200 by 2011, a 19 percent increase over the 168 students in 2002.

"We think the gradual increase will allow us to accommodate people and not affect their education," said Dr. Stephen Greenberg, Baylor's dean of medical education.

Stiff competition

Because the UT Medical School has added seats in recent years, enrollment will remain stable for the next few years, said Dr. Judianne Kellaway, assistant dean of admissions. But the number of applicants, which already has outpaced the increase in class size, is expected to continue to rise. Nearly 3,700 aspiring physicians applied this year — 5 percent more than last year.

"It's absolutely getting more competitive," said Kellaway, an ophthalmologist. "There are many, many good people out there who will just need to hold their dream in front of them and reapply."

William Lee, 21, a senior at Texas A&M University who interviewed recently at UT Medical School, attested that competition is stiff.

"The people you're fighting with for these spots, they're all very bright individuals," said the Houston native, who applied to about eight medical schools.

Though medical school enrollment is on the rise, increasing the number of residency positions is arguably more difficult. That's mainly because programs in most states depend largely on funding from the federal government through Medicare, and that funding has remained static for the past few years.

State funding in Texas, however, is improving. The Legislature this year approved an increase to $63 million for residency programs, the highest level ever and more than double the $25 million appropriated last year.

Some state money could go toward a new neurology residency program at the UT Medical School here. Dr. Dong Kim, chairman of the department of neurosurgery, said seven positions could be approved by January. Until then, the university offers residency in every specialty except neurology, he said.

Like the rest of the country, Texas does not have enough physicians to keep up with a growing population that demands more specialty services. It ranked 42nd in the country for its patient-to-resident ratio in 2005, with 194 patient-care physicians per 100,000 residents, according to the American Medical Association.

Lately, however, more doctors have applied for licenses in Texas, likely because of new limits in medical malpractice lawsuits that make it more appealing for physicians to practice here.

Fewer slots than New York

The number of residency positions available in Texas climbed to 7,260 slots during the 2005-06 school year, an increase of about 4 percent in two years, according to the Accreditation Council for Graduate Medical Education. That's far fewer slots than other populous states; New York, for example, had more than twice as many residents that year, partly because the state secured nongovernmental funding. Without enough positions for its graduates, Texas could lose physicians-in-training to other states.

Nationwide, the number of residency slots is increasing at a similar rate. About 115,100 positions were available across the country during the 2005-06 school year, the ACGME reported.

There's good reason to keep graduates in Texas for training, according to the Texas Medical Association, which represents physicians and medical students.

The group reported that physicians who complete both medical school and residency here are nearly three times more likely to stay in the state to practice.